Portegies Marileen L P, Wolters Frank J, Hofman Albert, Ikram M Kamran, Koudstaal Peter J, Ikram M Arfan
From the Department of Epidemiology (M.L.P.P., F.J.W., A.H., M.K.I., M.A.I.), Neurology (M.L.P.P., F.J.W., P.J.K., M.A.I.), and Radiology (M.A.I.), Erasmus University Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.).
Stroke. 2016 Aug;47(8):2119-22. doi: 10.1161/STROKEAHA.116.014094. Epub 2016 Jul 14.
Improved short-term survival after stroke has necessitated quantifying risk and risk factors of long-term sequelae after stroke (ie, recurrent stroke and dementia). This risk may be influenced by exposure to cardiovascular risk factors before the initial stroke. Within the population-based Rotterdam Study, we determined the long-term risk of recurrent stroke and dementia, and the proportion of recurrent strokes and poststroke dementia cases that are attributable to prestroke cardiovascular risk factors (ie, the population attributable risk).
We followed up 1237 patients with first-ever stroke and 4928 stroke-free participants, matched on age, sex, examination round, and stroke date (index date), for the occurrence of stroke or dementia. We calculated incidence rates in both groups and estimated the individual and combined population attributable risk of prestroke cardiovascular risk factors for both outcomes.
Beyond 1 year after stroke, patients retained a 3-fold increased risk of recurrent stroke and an almost 2-fold increased risk of dementia compared with people without stroke. In total, 39% (95% confidence interval, 18%-66%) of recurrent strokes and 10% (95% confidence interval, 0%-91%) of poststroke dementia cases were attributable to prestroke cardiovascular risk factors. These percentages were similar for first-ever stroke and dementia in the matched stroke-free population.
Long-term risks of recurrent stroke and poststroke dementia remain high and are substantially influenced by prestroke risk factors, emphasizing the need for optimizing primary prevention.
中风后短期生存率的提高使得有必要对中风后长期后遗症（即复发性中风和痴呆症）的风险及风险因素进行量化。这种风险可能会受到首次中风前接触心血管风险因素的影响。在基于人群的鹿特丹研究中，我们确定了复发性中风和痴呆症的长期风险，以及可归因于中风前心血管风险因素的复发性中风和中风后痴呆症病例的比例（即人群归因风险）。
我们对1237例首次中风患者和4928例无中风参与者进行了随访，根据年龄、性别、检查轮次和中风日期（索引日期）进行匹配，以观察中风或痴呆症的发生情况。我们计算了两组的发病率，并估计了中风前心血管风险因素对这两种结局的个体和综合人群归因风险。
中风后1年以上，与未中风者相比，患者复发性中风风险增加3倍，痴呆症风险增加近2倍。总体而言，39%（95%置信区间，18%-66%）的复发性中风和l0%（95%置信区间，0%-91%）的中风后痴呆症病例可归因于中风前心血管风险因素。在匹配的无中风人群中，首次中风和痴呆症的这些百分比相似。
复发性中风和中风后痴呆症的长期风险仍然很高，并且受到中风前风险因素的显著影响，这强调了优化一级预防的必要性。
